Provider Demographics
NPI:1508826488
Name:CHAN, ROBERT WING (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WING
Last Name:CHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 SOUTH GARFIELD AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5036
Mailing Address - Country:US
Mailing Address - Phone:626-576-7871
Mailing Address - Fax:626-576-7872
Practice Address - Street 1:1234 SOUTH GARFIELD AVENUE
Practice Address - Street 2:SUITE 103
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5036
Practice Address - Country:US
Practice Address - Phone:626-576-7871
Practice Address - Fax:626-576-7872
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A676780Medicaid
CAA67678Medicare ID - Type Unspecified
H14784Medicare UPIN